Estimates suggest more than two million people worldwide would benefit from an organ transplant. While the donation rates vary greatly between countries, the contrast between the increasing numbers of people in need and the inadequate numbers of organs being donated mean many will die while they wait.

Last night, ABC’s Four Corners screened Tales from the Organ Trade, an HBO documentary that highlights the desperation that links the world’s poor, who sell their organs, together with first-world recipients who buy them on the black market.

While accurate statistics are difficult to find, some suggest that up to 15% of the world’s transplants are performed using illegally obtained organs via an international black market web of organ brokers. The brokers bring recipients and donors together with transplant surgeons working out of fly-by-night medical clinics. The process is unregulated, illegal and the risks to both donor and recipient are high.

The documentary raises challenging questions about this illegal trade in organs that sometimes benefits both the donor and recipient and other times imperils the well-being of both. There are, no doubt, many more untold horror stories.

While some experts argue the sale of organs should be regulated and legalised, most medical professionals strongly discourage their patients from travelling overseas to undergo organ transplants because they have significantly poorer outcomes than those who receive transplants here.

So, with Australia widely regarded as a world leader in transplantation outcomes, what would compel anyone to consider such a risky proposition? And why would anyone participate in exploitation like this?

Although there has been a welcome increase to the numbers of donations recently, Australia’s rate of deceased donation remains relatively low, and our moderately high rate of living donation has fallen since 2008, despite programs in place to boost these numbers.

While donation rates measure the rate at which organ donations occur, transplant rates measure the actual number of transplants performed – the most accurate measurement of how a country fulfils the need for transplanted organs.

In 2008, there were 1203 transplant recipients from both living and deceased donors in Australia. Five years later, in 2013 this number increased to 1371 transplant recipients. While this improvement is welcome, it still places Australia in the bottom half of developed countries worldwide.

While Australia’s official organ transplant waiting list has been relatively constant for several years (at around 1,600), there are many, many more potential recipients whose lives would be saved or dramatically improved were they not excluded from our waiting list.

That’s because waiting lists reflect the supply, not the demand. Around 11,500 people in Australia are being kept alive on dialysis because they have end-stage kidney failure. About 1100 of the approximately 1600 people on the organ transplant waiting list in Australia are awaiting a kidney. If more kidneys were available, many more than the 1100 on the list would benefit greatly from a transplant.

These numbers are mirrored around the world: need is growing and people die waiting.

Organ donation is truly a gift of life. In Australia, this gift is made altruistically and often, in the case of deceased donation, at a time of personal grief and shock.

This so-called “organ shortage” has created an ideal marketplace for those willing to exploit the desperation of those on both sides of the transaction. The donors are almost always poor, living in a developing country where the judicial system does not offer ready protection for the underprivileged. Nor are their health-care needs met.

The Declaration of Istanbul on organ trafficking and transplant tourism roundly condemns – and attempts to curtail – the practice. Around 100 countries have strengthened their laws to prevent organ trafficking, notably China, Pakistan and the Philippines.

But while the Declaration of Istanbul, and, more recently, China’s formal agreement to stop using organs from executed prisoners for transplantation, provide much-needed progress toward curtailing the frequency of organ trafficking, the best solution is to increase organ donation to better meet the demand of those in need.

This article was co-authored by Sara Irvine, committee member of the organdonationrates.org project at the University of Sydney.